Articles

Mental Health Awareness: Much needed discussion in Nepal

May 2022 | NEPAL

*Trigger Warning – Description of Mental Health Crisis

Writer’s Note: The incidents described in the article are based on a true story. Due to privacy concerns, the patient’s personal information (including gender) is kept confidential.

What would you do if a good friend suddenly starts to tag you in their social media posts every other minute? Posts that are confusing to you and many others, posts that are political, philosophical and religious. Posts that directly defame and chastise senior respected individuals, Posts that you know for a fact, are very different from your friend’s nature. How would you respond?

I think you might try to contact them to comprehend what’s happening. What if no one responds and the situation is further complicated because they live alone in another city? I recently encountered one such bizarre situation, one that I had never expected to encounter even in my wildest dreams. 

A situation that made me realise how serious mental health issues can be.

All my attempts to converse with my friend had failed. I had no way of contacting their family, but because I knew where they were living, I rushed to see them, terrified for their safety. When I arrived at their place, I found them in a completely delusional state, abnormally upbeat, having an exaggerated sense of self, and by the looks of it, sleepless for many nights at length. 

I tried to calm them down, but they were convinced that they had been ‘enlightened’. I wasn’t sure of what was going on, but I knew they needed me. 

I got them back to their family, assuming that it was due to substance abuse and that once they detox, they will be okay. I took them to the doctors next, where they were diagnosed with ‘mania’

According to the American Psychiatric Association, Mania is defined as “a distinct period of abnormally and persistently elevated, expansive, or irritable mood along with abnormally and persistently increased activity or energy, lasting at least one week and present most of the day, nearly every day”. It is a type of bipolar disorder, commonly termed ‘bipolar one’. Our World in Data further reports that 0.6% of the world’s population, or roughly around 46 million people, suffer from this mental illness globally

This was clearly a major issue, but I was unaware of it until it arrived at my door. 

I had no idea what the term meant or how serious the condition is. I thought a few days of medication will help. Eventually, their symptoms started to diminish, and I felt (at that time) that things would get back to ‘normal’. But to everyone’s dismay, this became a common occurrence – they presented themselves as if everything was fine one day to completely flipping out the next, reduced sleep, becoming easily distracted, and having racing obsessive thoughts. All of which were increasingly visible on their social media posts, which also became more frequent and darker as the days passed – talking about topics such as the death of self, how no one understands them, how lonely they are, separation from family, and so on.

I grew frantic to get them the medical attention that I believed they needed. However, they outrightly rejected it. They refused medication claiming they had already taken it, or manipulated family members into believing that medication was no longer required. With the scenario getting back to where it all began, we were all going in circles and things became overwhelming. 

The real tragedy began when we took the friend to the doctor for treatment. We sought hospitalisation. However, the insensitivity of the nurses and doctors of some of Kathmandu’s renowned hospitals, as well as the blatant disregard for this urgent situation, was heartbreaking. 

When the patient realised that they were taken to the hospital, they sprinted and reached the main gate of the hospital. This occurred while we were waiting for treatment to begin – the hospital stated that they would not begin treatment until their administrative requirements were met. As a lawyer, I appreciate the need for ‘due process’, but just as a delay in justice can result in justice being denied, a delay in treatment can have severe consequences for the patient and those around them. It took five of us to calm the patient.

After a long and exhaustive endeavour during which, the hospital guards seized and sedated the patient, the arduous procedure of shifting from one hospital to another began since no beds were available. I wondered if this was the situation in purportedly normal times, when COVID cases are few, and what was it like during the pandemic when cases were high.

After almost 5 hours of the struggle for hospital beds, the patient was finally admitted. We all breathed a sigh of relief, knowing that the patient would now receive the right medication. We were very patient with the whole process until one fateful day; when the ward gate was left open by a doctor at the end of his shift. 

The patient fled the ward, taking advantage of the missing guard. We were terrified since the doctors claimed that “mania may also trigger a break from reality and there is a considerable risk that a patient with mania can harm themselves or others.” Fortunately, there were two of us with the patient on that day. I ran after them while the other person sought assistance from hospital staff. For a while, the patient walked around aimlessly and I kept a close eye while desperately seeking assistance from anyone I could locate.  

The patient walked to the main gate after taking a walk around the hospital. Following them, I noticed some security guards from afar, but to my surprise, when I asked the guards to intervene, they said that it was not their ‘responsibility’. The other family member who had gone to seek assistance was also present, pleading with the guards to take the patient in. But none of the guards helped. 

We were concerned that if the patient left the grounds, there would be no way to track them. Fortunately, luck was on our side. One of the guards struck up an instant friendship with the patient and persuaded them to come inside, promising that if they didn’t want to stay, the doctors would let them go. That worked, much to everyone’s relief.

For me, this particular experience was odd and surreal. The series of events made me realise how unprepared we are as a society to recognise, acknowledge, and provide medical treatment to those who require psychological and psychiatric help or other mental health support. 

According to Nepal’s National Mental Health Survey 2020, 10% of adults have experienced a mental disorder in their lifetime and 4.3% currently have a mental disorder. Only around 40% of adults were found to have told someone about their symptoms, and only 23% had sought therapy. This clearly reveals a significant gap in mental health treatment. Further, one of the major hurdles to accessing care is not knowing where to go for expert care. It is therefore critical to raise public awareness about various mental health conditions, treatments available, and where and how to access them. 

The experience made me realise that individuals working in technical sectors within hospitals, hospital administration, and even medical personnel stationed in non-specialist wards such as the emergency ward, are unaware of the numerous psychiatric illnesses and their manifestations. A significant section of the general public, including legislators, still believe that mental illness manifests itself in specific ways, such as individuals dressing in tattered clothes, mumbling to themselves, shouting, and crying, which do not represent the full spectrum of mental health issues. Nonetheless, we assume that mental illness is limited to these symptoms. 

People, particularly those involved in drafting legislation, must recognise that, like any other physical illness, mental illness improves with treatment. Improved understanding and empathy from loved ones, family and friends are necessary, but systematic state efforts are equally important. Recognising mental health issues as a crucial public health issue, realising the treatment gap, advocating for increased resources, and progressively advocating for the reduction of stigma and discrimination related to mental health, are some of the ways to institutionally strengthen mental health scenarios in Nepal.


Bandana Upreti – Junior Program Officer, iProbono, Nepal.

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